Truck Driver Application

Truck Driver Application Form
Contact Information
Legal Name*

First NameMiddle NameLast Name
Present Address*

Address 1

Address 2

CityState

Zip CodeCountry
Present Address*

Street Address

Street Address Line 2

CityState

Zip Code
Country*
Home/Alt. Phone Number

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Maiden Name
Marital Status
Email*

Confirmation Emailexample@example.com
Source/Referred by:*
How did you hear about us?
License Class*
Specific Job ID #
Application Information
Recruiter Name (If Known):
Personal Information

*Please be as thorough as possible and answer all required
Date of Birth*

MonthDayYear
Ex. 02/02/1975
Social Security #*
Do you live in the U.S.?*
Can you read, speak, and write English fluently?*
Years at Current Residence*
If '5+ Years' was NOT selected for the previous question, please list your address prior to your current address:
Can we, as well as any companies that you decide to move forward on, text you regarding future opportunities?:*

YesNo
Highest Level of Education *
Reference #1 Name:
Reference #1 Relationship:
Reference #1 Phone Number
Reference #2 Name:
Reference #2 Relationship:
Reference #2 Phone Number
Military Service

*If NO to the below question, please skip to the next section: License & Driving Information.
Were you ever in the military?*

YesNo
If YES, what branch?
Start Date:

MonthDayYear
End Date:

MonthDayYear
Honorable Discharge?

YesNo
License & Driving Information
License Class*
Drivers License State*
Drivers License Number*
Drivers License Expiration Date*

MonthDayYear
Physical Expiration Date*

MonthDayYear
Endorsements *
*Hold Ctrl/Cmd to select multiple items
Other Endorsements (If Applicable):
Hazmat Expiration Date (If Applicable):

MonthDayYear
Have you held any additional licenses in the last 3 years?*

YesNo
If yes to the above question, please provide the additional license information:
Do you possess a valid TWIC?*

YesNo
TWIC Expiration Date (If Applicable):

MonthDayYear
Do you possess a valid Passport?*

YesNo
Passport Expiration Date:

MonthDayYear
Date
Do you have a Sea Link card?*

YesNo
Which of the following do you have experience with?*
*Hold Ctrl/Cmd to select multiple items
What shift(s) do you prefer?*

First (8am-4pm)Second (4pm-12am)Third (12pm-8am)No Preference
Owner/Operator Information
Are you an owner operator? If NO, please skip to the next section: Driver Training School.*

YesNo
Number of trucks owned:
Truck Year
Truck Make
Truck Model
Do you own the truck outright?

YesNo
Empty Gross Weight:
Wheel Base:
5th Wheel Height:
Stack Height:
Driver Training School
Have you ever attended a driving school? If NO, please skip to the next section: Employment Information.*

YesNo
School Name:
School City:
School State
Graduation Date:

MonthDayYear
Date
Employment Information

Please list your most recent employer, self-employment, or contract work completed. If you have no recent employment, please list your most recent schooling attended in the employment section below.
Employer 1 (Most Recent Employer)
Date From*

MonthDayYear
Date To*

MonthDayYear
Employer 1 Name & Address*

First NameLast Name
Employer 1 Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Fax

Area CodePhone Number
Operate a CMV?*

YesNo
Vehicle/Truck Driven*
Trailer Type Hauled*
# of Days Out on the Road*
# of States Driven*
Trailer Length*
Reason for leaving?*
Please Explain:*
Additional Comments
May we contact this employer?*

YesNo
Do you have any additional employers (any type) in the last 3 years OR any additional driving employers (Class A or B CDL Jobs) within the last 3-10 years?*

YesNo
If YES to the above question, please add more Employer information below!
Add Further Employer History Here:
Employer Name: Dates Employed (To-From): Address: City: State: Zip: Phone: Operate a CMV?: Vehicle/Truck Driven: Trailer Type Hauled: # of Days Out on the Road: # of States Driven: Trailer Length: Reason for Leaving? (Explain) Additional Comments: May We Contact this employer? Employer Name: Dates Employed (To-From): Address: City: State: Zip: Phone: Operate a CMV?: Vehicle/Truck Driven: Trailer Type Hauled: # of Days Out on the Road: # of States Driven: Trailer Length: Reason for Leaving? (Explain) Additional Comments: May We Contact this employer? Employer Name: Dates Employed (To-From): Address: City: State: Zip: Phone: Operate a CMV?: Vehicle/Truck Driven: Trailer Type Hauled: # of Days Out on the Road: # of States Driven: Trailer Length: Reason for Leaving? (Explain) Additional Comments: May We Contact this employer?
How much commercial driving experience do you have that can be verified?*
*Please answer in text box provided
Have you been unemployed at any time during the last three (3) years for a period greater than ninety (90) days?*

YesNo
If YES to above question, please provide dates and reason:
Employment desired*

Full-Time OnlyPart-Time Only
Traffic Convictions
Do you have ANY traffic convictions within the last 5 years?*

YesNo
Traffic Conviction 1:
Date of Conviction

MonthDayYear
ex: 02-20-2002
Type of Vehicle Operating

Personally Operated Vehicle (POV)Commercial Motor Vehicle (CMV)
Conviction Type
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Traffic Conviction 2:
Date of Conviction

MonthDayYear
ex: 02-02-2002
Type of Vehicle Operating

Personally Operated Vehicle (POV)Commercial Motor Vehicle (CMV)
Conviction Type
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Traffic Conviction 3:
Date of Conviction

MonthDayYear
ex: 02-02-2002
Type of Vehicle Operating

Personally Operated Vehicle (POV)Commercial Motor Vehicle (CMV)
Conviction Type
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Traffic Accidents
Do you have ANY vehicle accidents within the last 5 years?*

YesNo
Accident 1
Date of Accident

MonthDayYear
Date
Accident Type
Vehicle Type

Personally Operated Vehicle (POV)Commercial Motor Vehicle (CMV)
DOT Recordable?

YesNo
Preventable/Non-Preventable?
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Accident 2
Date of Accident

MonthDayYear
Date
Accident Type
Vehicle Type

Personally Operated Vehicle (POV)Commercial Motor Vehicle (CMV)
DOT Recordable?

YesNo
Preventable/Non-Preventable?
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Accident 3
Date of Accident

MonthDayYear
Date
Accident Type
Vehicle Type

Personally Operated Vehicle (POV)Commercial Motor Vehicle (CMV)
DOT Recordable?

YesNo
Preventable/Non-Preventable?
Additional Explanation:
Supporting Documents:

Choose File
*You may choose more than one file if needed Cancelof
Background History

Please answer the following questions as accurately as possible including date, charge, and any additional comments you'd like. Please note that any previous convictions will not result in being denied employment. Providing the best explanation possible will allow us to best help you find a job!
Do you have any felony convictions within the last ten (10) years?*

YesNo
If yes to the above question, please explain:
Do you have any misdemeanor convictions within the last five (5) years?*

YesNo
If yes to the above question, please explain:
Have you ever had a drug conviction?*

YesNo
If yes to the above question, please explain:
Have you ever been charged with DUI/DWI?*

YesNo
If yes to the above question, please explain:
Have you ever had your license suspended, denied and/or revoked, or refused liability insurance?*

YesNo
If yes to the above question, please explain:
Have you ever been charged with Reckless Driving or Driving to Endanger?*

YesNo
If yes to the above question, please explain:
Have you ever tested positive or refused a pre-employment drug screen or a random drug screen?*

YesNo
If yes to the above question, please explain:
Confirmation & Submission

*I confirmed that the information is true and correct to the best of my knowledge.
Signature (Type Full Name):*
Today's Date*

MonthDayYear
Please enter the last four digits of your Social Security Number to confirm your submission:*
Position(s) applied for:
Job Title
Job Location Desired
TWIC Expiration Date (If Applicable)

MonthDayYear
Should be Empty:

Truck Driver Application Form

Contact Information

Application Information

Personal Information

Military Service

License & Driving Information

Owner/Operator Information

Driver Training School

Employment Information

Traffic Convictions

Traffic Accidents

Background History

Confirmation & Submission